All-Cause Hospital Admissions Among Older Adults After a Natural Disaster.

Study Objective: We characterize hospital admissions among older adults for any cause in the 30 days after a significant natural disaster in the United States. The main outcome was all-cause hospital admissions in the 30 days after natural disaster. Separate analyses were conducted to examine all-cause hospital admissions excluding the 72 hours after the disaster, ICU admissions, all-cause inhospital mortality, and admissions by state.

Late mortality after acute hypoxic respiratory failure.

Background: Acute hypoxic respiratory failure (AHRF) is associated with significant acute mortality. It is unclear whether later mortality is predominantly driven by pre-existing comorbid disease, the acute inciting event or is the result of AHRF itself.

Methods: Observational cohort study of elderly US Health and Retirement Study (HRS) participants in fee-for-service Medicare (1998-2012).

Individual and health system variation in rehospitalizations the year after pneumonia.

Little is known about variation in patterns of recovery among patients discharged alive from hospitalizations for pneumonia.The aim of the is observational cohort study was to characterize the variation in patterns of hospital readmission and survival in the year after discharge for pneumonia in 3 different health systems.The 3 cohorts consisted of (1) the Health and Retirement Study participants enrolled in Fee-for-service Medicare (FFS), (2) Veterans Administration (VA) Healthcare system, and (3) Kaiser Permanente of Northern California (KPNC).

Increased healthcare facility use in veterans surviving sepsis hospitalization.

Purpose: We sought to measure inpatient healthcare utilization among U.S. Veteran Affairs beneficiaries surviving sepsis hospitalization, and to examine how post-sepsis utilization varies by select patient characteristics.

The rapid and accurate categorisation of critically ill patients (RACE) to identify outcomes of interest for longitudinal studies: a feasibility study.

The capacity to measure the impact of an intervention on long-term functional outcomes might be improved if research methodology reflected our clinical approach, which is to individualise goals of care to what is achievable for each patient. The objective of this multicentre inception cohort study was to evaluate the feasibility of rapidly and accurately categorising patients, who were eligible for simulated enrolment into a clinical trial, into unique categories based on premorbid function. Once a patient met eligibility criteria a rapid 'baseline assessment' was conducted to categorise patients into one of eight specified groups.

The impact of disability in survivors of critical illness.

Purpose: To use the World Health Organisation's International Classification of Functioning to measure disability following critical illness using patient-reported outcomes.

Methods: A prospective, multicentre cohort study conducted in five metropolitan intensive care units (ICU). Participants were adults who had been admitted to the ICU, received more than 24 h of mechanical ventilation and survived to hospital discharge.

Identifying Barriers to Delivering the Awakening and Breathing Coordination, Delirium, and Early Exercise/Mobility Bundle to Minimize Adverse Outcomes for Mechanically Ventilated Patients: A Systematic Review.

Background: Improved outcomes are associated with the Awakening and Breathing Coordination, Delirium, and Early exercise/mobility bundle (ABCDE); however, implementation issues are common. As yet, no study has integrated the barriers to ABCDE to provide an overview of reasons for less successful efforts. The purpose of this review was to identify and catalog the barriers to ABCDE delivery based on a widely used implementation framework, and to provide a resource to guide clinicians in overcoming barriers to implementation.

Psychiatric Symptoms in Survivors of Acute Respiratory Distress Syndrome. Effects of Age, Sex, and Immune Modulation.

Rationale: Psychiatric morbidity after acute respiratory distress syndrome (ARDS) is common, and our current ability to predict psychiatric symptoms based on patient- and illness-specific factors is limited.

Objectives: We assessed symptoms of anxiety, depression, and posttraumatic stress disorder (PTSD) in long-term survivors of ARDS, as well as the associated changes in cortisol levels.

Methods: The participants were enrolled in a randomized, double-blind, placebo-controlled trial of granulocyte macrophage-colony stimulating factor (GM-CSF) or placebo conducted at three academic medical centers.

The Timing of Early Antibiotics and Hospital Mortality in Sepsis.

Rationale: Prior sepsis studies evaluating antibiotic timing have shown mixed results.

Objectives: To evaluate the association between antibiotic timing and mortality among patients with sepsis receiving antibiotics within 6 hours of emergency department registration.

Methods: Retrospective study of 35,000 randomly selected inpatients with sepsis treated at 21 emergency departments between 2010 and 2013 in Northern California.

The ICM research agenda on intensive care unit-acquired weakness.

We present areas of uncertainty concerning intensive care unit-acquired weakness (ICUAW) and identify areas for future research. Age, pre-ICU functional and cognitive state, concurrent illness, frailty, and health trajectories impact outcomes and should be assessed to stratify patients. In the ICU, early assessment of limb and diaphragm muscle strength and function using nonvolitional tests may be useful, but comparison with established methods of global and specific muscle strength and physical function and determination of their reliability and normal values would be important to advance these techniques.

The Untapped Potential of Patient and Family Engagement in the Organization of Critical Care.

Objective: There is growing interest in patient and family participation in critical care-not just as part of the bedside, but as part of educational and management organization and infrastructure. This offers tremendous opportunities for change but carries risk to patients, families, and the institution. The objective is to provide a concise definitive review of patient and family organizational participation in critical care as a high-risk population and other vulnerable groups.

Intensive Care Unit Admission and Survival among Older Patients with Chronic Obstructive Pulmonary Disease, Heart Failure, or Myocardial Infarction.

Rationale: Admission to an intensive care unit (ICU) may be beneficial to patients with pneumonia with uncertain ICU needs; however, evidence regarding the association between ICU admission and mortality for other common conditions is largely unknown.

Objectives: To estimate the relationship between ICU admission and outcomes for hospitalized patients with exacerbation of chronic obstructive pulmonary disease (COPD), exacerbation of heart failure (HF), or acute myocardial infarction (AMI).

Methods: We performed a retrospective cohort study of all acute care hospitalizations from 2010 to 2012 for U.

Core Domains in Evaluating Patient Outcomes After Acute Respiratory Failure: International Multidisciplinary Clinician Consultation.

Background: There is increasing interest in measuring the quality of survivorship for patients admitted to the intensive care unit for acute respiratory failure (ARF). However, there is substantial variability in patient outcomes reported in studies evaluating these patients, with few data on which outcomes are essential to inform clinical practice.

Objective: The objectives of this study were to determine clinicians’ perspectives on the outcome domains that should always be reported in studies evaluating people who have had ARF after hospital discharge and to compare findings about US and Australian perspectives.

Do Clinicians Understand Quality Metric Data? An Evaluation in a Twitter-Derived Sample.

Objective: Despite significant efforts and cost, quality metrics do not consistently influence practice. While research has focused on improving data through statistical risk-adjustment, whether clinicians understand these data is unknown. Therefore, we assessed clinician comprehension of central line-associated blood stream infection (CLABSI) quality metric data.

Can longitudinal generalized estimating equation models distinguish network influence and homophily? An agent-based modeling approach to measurement characteristics.

Background: Connected individuals (or nodes) in a network are more likely to be similar than two randomly selected nodes due to homophily and/or network influence. Distinguishing between these two influences is an important goal in network analysis, and generalized estimating equation (GEE) analyses of longitudinal dyadic network data are an attractive approach. It is not known to what extent such regressions can accurately extract underlying data generating processes.

Associations between community-level disaster exposure and individual-level changes in disability and risk of death for older Americans.

Disasters occur frequently in the United States (US) and their impact on acute morbidity, mortality and short-term increased health needs has been well described. However, barring mental health, little is known about the medium or longer-term health impacts of disasters. This study sought to determine if there is an association between community-level disaster exposure and individual-level changes in disability and/or the risk of death for older Americans.